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7.02.2012

The Natural Products Industry that Isn’t.

A few evenings ago I was sitting on a rough cedar deck, watching sunlight orange across
the topsof the poplar and maple canopy,
and thinking how nice it was to be visiting my friend’s house in the forest:
the nestled feeling, the total privacy, the familiar smells. He confessedthat, sometimes, he too liked to imagine his
house from the perspective of a guest, walking through his gardens, up the
wooden steps, and into the kitchen with the eye of an outsider, taking the time
to appreciate it without the preconceptions and perceptual habits that develop
after living in a place for an extended period of time. Perhaps it was the
effects of the mixture of Schisandra kombucha, gin, and tonic water we were
drinking, but this short exercise in mindfulness seemed to me as both a useful
habit to practice and also a profoundly important skill for the modern human.
We are so entrenched in our politics, our communities, our niches and
worldviews that, without occasionally looking at life from outside the fences,
we might run the risk of missing out on an important and useful perspective.

I have
also been thinking a lot about the Food and Drug Administration recently. Don’t
get me wrong – there are serious issues around funding, connections to the food
and pharma lobbies, and separation from nature that continue to concern me
about this regulatory body’s work. But I have been trying to walk these
familiar corridors (herbalists versus the FDA) with an outsider’s eye. In the
last year, there have been more and more inspections of natural product
manufacturing facilities. The government is trying to identify “new” dietary
ingredients and regulate their use. There is both clamor and confusion rising
up from those who make and sell products that are used under the umbrella of
“complementary and alternative medicine”.What is going on here, and why? What might we learn by observing the
situation?

Since 1994, when the US Congress passed the Dietary
Supplements Health and Education Act (DSHEA), we have seen many, many new
“dietary supplements” on the shelves of our food stores and pharmacies. Many of
these products have come on to the market because DSHEA allows a fuzzy “gray
zone” between food and medicine: while recognizing that supplements are more
than vegetables, it doesn’t require that they be tested for safety and efficacy
the way prescription and over-the-counter drugs are. This has allowed a
profitable industry to grow in the United States, where annual sales of
products labeled as “natural” and falling under the legal aegis of DSHEA top $28
billion, according to the Nutrition Business Journal. (http://newhope360.com/2010-supplement-business-report-0)

Out of
these annual sales, herbal products account for about five billion annual
dollars, or just under 18% of the total. Within this five billion, it is hard
to assess what percentage of products are made from refined, concentrated
botanical constituents (such as curcuminoids, or silymarin) versus crude
whole-plant encapsulations, tea blends, and tinctures – but suffice it to say, the
bulk of that five billion annual dollars is not finding its way into the
pockets of small-scale, heart-centered local herbalists! So, in sum, at least
82% and probably over 90% of what makes up the “natural products” industry
isn’t “natural” at all: it is either a cocktail of vitamins and minerals, a
sports nutrition or meal replacement product built up from processed
constituents, or some other mixture of naturally-derived, refined, or outright
synthetic ingredients. We may have encountered pieces of these products in
nature at some point, but never at these doses. In certain cases, they are
completely new to our physiologies.

Take
the case of grapefruit seed extract. The FDA has been warning manufacturers of
this “natural” antiseptic and antibiotic agent that their products may contain
triclosan (an antiseptic linked with bacterial resistance and toxicity); the
American Botanical Council suspects that these extracts are adulterated
purposefully to increase their antibiotic power (http://cms.herbalgram.org/herbalgram/issue94/QUALCONTROL_gfse.html).
Others feel that the extensive processing that the original grapefruit seed slurry
undergoes actually generates triclosan-like compounds (http://herbsandinfluenza.com/blog/2006/12/22/grapeseed-extract-explained/).
Regardless, you either have an adulterated product (falsely labeled!), or a
product that has undergone extensive chemical alteration, resembling grapefruit
seeds less than high fructose corn syrup resembles an ear of corn. This isn’t a
natural product at all.

So
whether it be an antibiotic derived from chemical manipulation, a mega-dose
vitamin, a solvent-extracted slurry of connective tissue from a shark, or a
digestive enzyme obtained from a genetically-modified Aspergillus fungus, I fear that our “natural” products bear little
resemblance to those found on the shelves of natural food stores in the
1980s.Even more disturbingly, most of
what’s out there (with a few rare exceptions, like folic acid) shows very little
evidence of helping for any problem whatsoever. Where do we see a consistent
body of research and a rich depth of traditional use? It’s in herbal medicine –
less than 1/5 of what’s on the shelves. Most of these other “natural” products
are marketed on the basis of petri dish experiments, fruit fly studies from
fifty years ago, anecdotal testimonials, or in some cases, just snazzy
packaging. Some of them contain toxic, drug-like ingredients. It is no wonder
the FDA is trying to get a handle on this situation (as it already has with the
amphetamine-like additive DMAA http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302133.htm).
It is also no wonder that we are starting to see more and more reports of
vitamins, minerals, and other supplements potentially doing us more harm than
good: they are at best weak drugs, and at worst untested, potentially unsafe,
chemical additives.

What
put this over the top for me was a discussion I had when I recently visited
Bastyr University, the premier training ground for naturopathic physicians in
the United States. Out of the 299 credits required for graduation, there are
five credits devoted specifically to botanical medicine. Over seventeen are
assigned to physical medicine (somatic therapies involving touch, manipulation,
etc), and over eight for homeopathy (http://www.bastyr.edu/academics/areas-study/study-naturopathic-medicine/naturopathic-doctor-degree-program#Curriculum).
Where are the herbal materia medica classes? Where are the topics on complexity
in medicine, the study of interactions between multilayered living botanicals
and multilayered living humans? These are the roots of naturopathic medicine,
but they seem to be nourishing less and less of the Bastyr curriculum these
days. So can we really be surprised that some practitioners recommend abstracted,
drug-like “natural” products to their patients instead of teaching them to brew
tea and walk in the forest?

Natural
products aren’t real, folks – but fortunately,herbal medicine is. Herbal medicine is traditional medicine – for over
80% of the world, but for us in the “developed” world, too. Along with ancient
somatic and energetic therapies like massage and acupuncture, all tied together
by a rich and meaningful mythology, herbal medicine makes up this tradition.
Modern alternatives – be they the mainstream technological medicine, or “CAM”
technological medicine – are just that: a different choice, some of which is well
validated for use in health care, some of which lacks any validation
whatsoever. But neither prescription drugs, over-the-counter pills, or that 80%
of “natural” dietary supplements can come close to providing the breadth,
depth, and accessibility of true traditional medicine.

It is
time for herbalists to affirm that our plants are not “complementary and
alternative” to technological medicine. Our medicine is real, and just as real
vegetables are not a complement to frozen dinners and meal replacement shakes,
true botanical medicine is not some kind of extra adjunct to pharmaceuticals
and surgical interventions. It is a birthright. It is a daily gift. Its memory
is visibly encoded in our genetic material. And it is being practiced
everywhere, in kitchens and apothecaries, in modern production facilities and
improvised forest clinics. We as herbalists – the growers, the clinicians, the
wildcrafters, the medicine-makers, the keepers of wortcunning, the storytellers
– have been sinking our roots back into the tradition over the last few
decades. Now, having moved well past the embryonic stage, and our cotyledons
fully unfurled, it is time to rise up and proclaim what makes us unique: we are
traditional medicine, we are integrated ecology, we are plants. Argue all you
want about what is “mainstream” and what is “alternative” – we as herbalists
are neither. We are tradition, we hold the roots. Now let’s stand up and let
others know the deal. As Rima Staines
simply put it (http://intothehermitage.blogspot.com/2012/01/rise-root.html):
rise and root. Think as a plant does: up, up! and down, down! One movement in
many directions, many directions with one focus.

That is a great article Guido. Your strong herbal voice adds to the pride I feel for being a herbalist. I worked for a few years as a rep for a supplement company to naturopaths, I enjoyed the work but would light up when I met a naturopath that loved herbs and had a apothecary of tinctures and teas. Often though I was told it just wasn't worth the bother that it was just too complicated and laborious. Instead there would be rows of pill bottles with standardized extracts, gland extracts and vitamins/minerals. I have often thought that there is something about the business of alternative/complementary medicine that suffocated the herbalism.

Great article. Really glad to have stumbled across your blog, Guido, and a bit serendipitous, too, as I'm about to be making my way back to Vermont for the summer. I've just finished my second year of a Chinese Medicine program nested within a naturopathic college, NCNM in Portland. I can report that, while NCNM's ND program has a reputation for being funkier and truer to naturopathy's roots than Bastyr's program, most of the ND students I've spoken with feel that their "bot med" training doesn't prepare them very well for clinical work. I'd guess that only a small percentage really consider themselves herbalists, though the majority are comfortable slinging mega-dose vitamins and adrenal support complexes. In the Chinese Medicine program, we spend a lot of time learning herbs and formula, but what's lacking is intimate connection to the plants. Luckily there are more and more people like yourself doing the work to start putting Eastern and Western herbal traditions into meaningful conversation. Thanks, keep it up, and hope to run into you this summer at VCIH!

Sabra, that's exactly the experience I had at Bastyr. White-coated salesforce presenting lots of "natural" products. For a moment, I felt helpless in the face of the industry - but of course, we're not.

Jonny, a Chinese medicine program is inherently more botanical than an ND program. But the point you make - proprietary herbal blends and not so much gardening - is valid for sure. Look forward to seeing you in Vermont.

Excellent article - absolutely true and very insightful. So important for herbal medicine to distinguish itself from the pervasive industry of "natural" products. Love this: "True botanical medicine is not some kind of extra adjunct to pharmaceuticals and surgical interventions." Well said.

Guido, I completely agree with the sentiments of your article and continually work to inspire and change the focus back towards herbalism as you and I understand it. Bastyr actually has 13 credits required plus another 20+ credits of field classes and traditional medicine making available to them. I wish we had had time to speak more about this. Certainly the naturopathic programs tend to lose their herbal focus as the other modalities are added on and it is a constant battle between these modalities and the students personal interests in each one which makes it all the more difficult. More focused programs like our Bachelors program and other's Masters programs help to produce more traditional herbalists but we need more accredited programs to do so to keep it alive and to train herbalists well in traditional herbalism as well as the industry analytical methods do that we can communicate effectively with the FDA.

Sheila, thank you so much for your comment and the clarification regarding Bastyr's offerings in herbal medicine. I was having a hard time piecing together the requirements for herbal medicine in the ND program, so I really appreciate the direct information. I am frustrated that herbalists such as yourself feel that they have to struggle to keep plants at the forefront of the naturopathic curriculum, when it's herbal medicine that has the best track record and scientific basis (at least when considering therapies administered orally). I sometimes wonder if there are other forces pushing back against the herbalists' agenda: we are quick to point out the collusion between pharma and mainstream technological medicine, but what about between the "natural" products industry and institutions such as Bastyr? The products fair I visited made me afraid of such a connection which, though probably involuntary, may be affecting the curriculum more than we as herbalists realize...

Absolutely, in fact Bastyr is working on some policy changes to decrease the supplement industry's influence on students critical thinking and changing the impression that a supplement will work as well or is easier. We also have a huge curriculum overhaul beginning next year in which 3 quarters of herbal studies have bern added in the areas of history, pharmacognosy and medicine making in addition to 5 quarters of hands on case based herbal formulation studies. These are on top of what we already had in place. So I'm hoping to affect this change we both seek for sure.